Healthcare Provider Details

I. General information

NPI: 1639352263
Provider Name (Legal Business Name): ALAN C DAVIS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 05/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 HILLRISE DR
LAS CRUCES NM
88011-4703
US

IV. Provider business mailing address

3005 HILLRISE DR
LAS CRUCES NM
88011-4703
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-1122
  • Fax: 575-521-1299
Mailing address:
  • Phone: 575-521-1122
  • Fax: 575-521-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number83-185
License Number StateNM

VIII. Authorized Official

Name: ALAN C DAVIS
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 575-521-1122